AIDS cases in Ottawa: A review of simultaneous HIV and AIDS diagnoses

Abstract Objectives In Canada, HIV diagnoses continue unabated, with many of these cases being identified at a late stage of infection. While current public health surveillance data does not capture timing of diagnoses, locally, we identified a number of patients concurrently diagnosed with AIDS and HIV. Design To understand the key characteristics, presenting symptoms, and risk factors associated with an AIDS diagnosis, we undertook a prospective chart review of HIV and AIDS diagnoses in Ottawa, Canada. Sample Sixty seven charts of persons diagnosed with HIV and AIDS between 2015 and 2021 were reviewed. Measurements Data were analyzed using descriptive statistics. Results Results show some inconsistencies regarding HIV risk factors identified in published literature compared to those for persons diagnosed with AIDS in this study. Namely, patients in this review were more likely to be male, Black (from HIV‐endemic regions), and heterosexual, and were diagnosed at critical stage in infection (total average CD4+ count of 92.9 cells/mm3) with 44.8% of patients concurrently diagnosed with one or more AIDS‐related opportunistic infections. Conclusions The findings can be applied to strengthen HIV screening efforts in primary care settings, particularly among patients who present with persistent symptoms or illnesses related to chronic HIV infection. Additional considerations should be made for public health nurses to provide counseling and linkage to HIV testing/prevention services for patients at the time of an STI or Tuberculosis diagnosis and to increase AIDS‐specific data collection.


BACKGROUND
Despite the availability of free HIV testing services through various clinical and peer-based settings across Canada, many persons continue to be diagnosed with HIV in a late disease stage, which is defined as occurring over 5 years from HIV acquisition Markwick et al., 2014;Muelas Fernandez et al., 2020;Public Health Agency of Canada [PHAC], 2019). While advancements in HIV treatment can restore most immune cell function, some opportunistic infections can cause permanent sequelae or death (O'Byrne & Orser, 2020;Poorolajal et al., 2016). This situation is more pronounced in persons who have progressed to AIDS, which, in Canada, is defined as having a CD4+ cell count of < 200 cells per cubic millimeter (cells/mm 3 ) and/or the presence of AIDS-related opportunistic infections (PHAC, 2016

Ethics
Approval for this study was obtained by the Ottawa Public Health ethics committee following a low-risk score on the Public Health Ontario (2019) risk screening tool. Based on this score and the fact this review involved mandatory public health surveillance data, formal ethics board approval and individual consent from patients was not required. Risk of harm to patients was also considered negligible based on findings from the risk screening tool.

Immigration status
Over one third (n = 26) of participants were born in Canada. The remaining two thirds (n = 41) were born outside of Canada, of whom

HIV testing
We identified five primary locations of HIV/AIDS diagnosis among our patients: 32.8% (n = 22) were during in-patient hospital admissions, 23.8% (n = 16) were in specialist clinics, 19.4% (n = 13) were in primary care and walk-in settings,16.4% (n = 11) were during immigration medical examination, and 7.5% (n = 5) were in emergency or

Presenting symptoms
Of the 67 patients diagnosed with AIDS, nine presented without symptoms (five males and four females). The other 58 patients presented with multiple symptoms affecting multiple systems. A complete list of symptoms can be found in Table 3. Some of the predominant symptoms associated with an AIDS diagnosis in this review included: weight loss greater than 10% of body-weight and loss of appetite (n = 34/58 or 58.6%); unexplained fever and malaise (n = 25/58 or 43.1%); dyspnea or dry cough (n = 25/58 or 39.7%); recurrent oral thrush (n = 21/58 or 36.2%); and chronic fatigue and lethargy (n = 20/58 or 34.5%).

AIDS diagnosis
For 37 (1)  In terms of recommendations for public health practice, we suggest public health nurses provide counseling on, and make recommenda-tions for, HIV testing for persons from at-risk groups who are diagnosed with an STI (e.g., chlamydia, gonorrhea, syphilis, hepatitis B, hep-

CONCLUSION
The HIV acquisition all-together. Finally, increased efforts should made for public health units and departments to collect demographic and riskrelated data on patients diagnosed with AIDS, as these were found to differ from HIV-specific data so as to HIV screening efforts.

ACKNOWLEDGMENTS
The team would like to thank the Ontario

ETHICAL STATEMENT
This study involved a prospective chart review of the Ontario public health database patients diagnosed with AIDS at the time of HIV diagnosis. Ethics approval was obtained by the Ottawa Public Health ethics committee following a low-risk score on the Public Health Ontario risk screening tool. Formal ethics board approval and individual consent from patients was not required for this study.

CONFLICT OF INTEREST
We confirm the information contained in this manuscript has not been published elsewhere and is not currently under review with an alternate journal.

DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.